Holland: Bending the rules?

Euthanasia has been commonplace in Holland for 25 years, and legal challengehas been rare.

It has not been a criminal offence in Holland since 1984, when courts and the Royal Dutch Medical Association drew up strict guidelines for doctors.

The new law change will remove any possibility that doctors will be prosecuted for carrying out euthanasia.

But the controls already in place are failing, according to a recent report in the British Medical Journal.

That finding led campaigners to warn against decriminalising the practice in the UK.

Lethal injection

Approximately 4,000 patients a year die through active euthanasia in the form of a lethal injection that kills in minutes.

Over half of Dutch doctors have performed mercy killings with the required consent and consultation and at least 90% of the population support euthanasia.

The BMJ study found that in 1995 almost two thirds of cases of euthanasia and physician-assisted suicide went unreported.

One in five cases of euthanasia occurred without the patient's explicit request, and in 17% of such cases, alternative treatment was available in contravention of the guidelines.

Dutch law requires patients to experience "unbearable suffering" to justify euthanasia.

But more than half the doctors surveyed said the main reason given by patients for the request was "loss of dignity". Almost half said they took action "to prevent further suffering".

They researchers concluded: "The reality is that a clear majority of cases of euthanasia, both with and without request, go unreported and unchecked.

"Dutch claims of effective regulation ring hollow."

Changes in law

The proposed changes in Dutch law have the broad support of politicians.

Willie Swiden, of the Dutch All-Party Justice Committee, said: "We want to change the penal code so that euthanasia will stay a crime offence, but when the doctor handles it properly, meets all the criteria and reports properly there will be no possibility of prosecution."

But there are fears that the system is already being abused.

Anecdotal evidence suggests that some elderly people carry cards saying they do not want euthanasia. It is said they fear what will happen if they are suddenly hospitalised.

Opponents of euthanasia warn that the liberal attitude to euthanasia is fraught with dangers.

They say euthanasia has been offered to people suffering from depression, or even as a convenience.

Dr Ben Zylicz, of the Dutch League of Doctors, said: "I have heard about a patient where the family came from Canada because of planned euthanasia.

"The patient said, 'no, not today I don't want it anymore' and everybody pressed him saying 'look your family came from Canada, they cannot do it again'.

"In a country where euthanasia is accepted this kind of thing can happen."